Kathmandu: He was not born in the United States. Nor did he spend his formative years there. But he has left an indelible mark on a rural county in New York State in the field of gastroenterology. His first encounter with the United States didn’t occur until his twenties, yet his expertise and dedication in gastroenterology have earned him lasting recognition and respect within the local community.
He is Bishnu Sapkota. And he is from Nepal.
Dr Sapkota, originally from Gaindakot, a small municipality located 150 kilometers east of Kathmandu, dedicated six years of his professional life to serving the rural community in Oswego County of New York. During this period, his unwavering commitment and exceptional medical care made a profound impression on the local residents. To this day, when individuals in the region face gastroenterological issues, Dr Sapkota’s name continues to resonate as a trusted and cherished healthcare provider.
Despite having left his position at Oswego Health more than six years ago, Dr Sapkota continues to receive calls from local physicians seeking his medical guidance and advice. These ongoing requests for his expertise are a testament to the enduring impact he has had on the community.
“As a doctor, it gives me immense satisfaction,” Dr Sapkota says.
Even today, every month during one weekend, Dr Sapkota covers the hospital, and he is always asked, “When will you come back to Oswego Hospital?”
In 2011, after completing his gastroenterology fellowship from New York Methodist Hospital (now called New York Presbyterian Brooklyn Methodist Hospital) and Interfaith Medical Center, he started practicing at Oswego Hospital, Oswego, New York. His reputation as a skilled and caring physician grew steadily in this county, which is located on the border with Canada.
At this hospital, patients were so impressed by his care that they even recommended him to their children and grandparents, extending his reach throughout the county.
“You had such a formidable reputation here. Why did you decide to leave your job?” Dr Sapkota turned thoughtful the moment I asked him this question. “You see,” he began, “I didn’t want to leave this position. The patients and the community meant a lot to me, but as my kids were growing up, I realized that I needed to dedicate more time to my family.”
“While the clinical exposure in Nepal is commendable, the teaching of effective communication skills and fostering a patient-centric approach remain a significant gap in the system.”
“Secondly, I’ve always had a burning desire to be more involved in the academic field. I wanted to teach, to nurture the next generation of medical professionals, and to help produce excellent doctors. It was a difficult decision, but I had to follow this passion and the opportunity it presented.”
Leaving Oswego Health as a full-time physician in 2017, he joined as a full-time teaching faculty and started working at Syracuse VA Medical Center and Upstate Medical University, where he teaches and trains gastroenterology fellows, residents, and medical students.
“If so, do you plan to return to private medical practice?” I asked. “For now, no,” he replied.
Dr Sapkota is currently an assistant professor at Suny Upstate University and a part of core faculty for gastroenterology fellowship program.
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Hailing from a middle-class family, Dr Sapkota’s family was involved in farming. The family’s hard-earned money sent him to an English school. An ace student, Dr Sapkota’s brilliance shone through when he topped the School Leaving Certificate Test exam in the entire Chitwan district in 1994. He continued his further education at St Xavier’s Campus in Kathmandu for his Intermediate in Science. His academic journey took a significant turn when he secured a full scholarship allowing him to pursue medical education from Manipal College of Medical Sciences in Pokhara of Kathmandu University. Dr Sapkota graduated from Manipal in 2003 as the most outgoing student of his batch and was also awarded TMA PAI gold medal.
At Manipal, he encountered a diverse mix of students, including NRI (Non-Resident Indians) from Australia, United States, students from Sri Lanka, and India, with at least 20 percent of the students comprising foreigners. Interacting with these international peers ignited a strong desire to come to the United States, serving as a major motivator for his future endeavors. Another reason for him to pursue medical education in the US was because of limited available residency positions in Nepal.
“I come from a family engaged in farming. Growing up, I had to pursue something more. I knew I had no other choices. Either I had to immerse myself in farming or strive for excellence in academics,” he said.
Another factor, according to him, to pursue foreign education was driven by motivation by his friends and seniors. During his undergraduate course at Manipal, many of his friends were preparing for the PLAB (Professional and Linguistic Assessments Board) and USMLE (United States Medical Licensing Examination). Dr Sapkota, too, embarked on his USMLE journey, starting his preparations in his fourth year of medical school. He relied on borrowed books from friends and seniors to equip himself for the challenge.
Initially, he had aspirations to return to Nepal and contribute to his community through his medical practice,but he could not for reasons he explains in a while.
After successfully clearing USMLE Step I and Step II, in August of 2004, Dr Sapkota made his journey to the United States. He obtained his ECFMG (Educational Commission for Foreign Medical Graduates) certification after clinical examination, which was a significant milestone. He then attended interviews in pursuit of his medical career. Dr Sapkota’s determination led to pre-match offers, and he couldn’t let go of the opportunity, opting for a pre-match agreement to secure a position. Interfaith Medical Center in Brooklyn became the institution where he successfully secured a pre-match, marking the beginning of his medical career in the USA.
A pre-match happens when a residency program offers a placement to a medical residency applicant prior to the main National Resident Matching Program (NRMP) match date.
The decision to accept a pre-match rather than waiting for NRMP match date, according to him, was driven by practical considerations. Dr Sapkota had limited financial resources, and his savings were depleting rapidly and finding and arranging accommodations for more interviews in new places also became challenging.
“Hence, I couldn’t risk letting this opportunity slip away,” he shares.
Dr Sapkota commenced his internal medicine residency in July in 2005, and his exceptional performance continued to shine. He consistently excelled, earning the title of “Best Outgoing Resident” during the first and third years of his residency. His dedication and prowess in the medical field were further recognized when he received the “Deepa Chandar Memorial Award for Best Outgoing Resident” in his final year of residency. These accolades prove his remarkable achievements and commitment to excellence in the field of internal medicine.
Dr Sapkota initially aspired to become a surgeon after completing his MBBS. He even dedicated six months to a surgical rotation after his internship. Although he liked surgery, he, during this rotation, realized that he would want a career little different than pure surgery that would allow him to utilize his dexterity and knowledge of medicine to manage medical problems.
During his residency, he faced the pivotal decision of choosing a medical specialty. After careful consideration, he opted for gastroenterology.
Dr Sapkota was accepted as a gastroenterology fellow in July of 2008 at New York Methodist Hospital (now called New York Presbyterian Brooklyn Methodist Hospital). After completing his fellowship in June 2011, he joined Oswego Health as a gastroenterologist.
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After delving into his remarkable medical journey, our conversation took a turn towards the disparities between Nepal’s healthcare system and that of the United States. With a reflective gaze, he expressed, “The contrasts are stark, but one should not make a judgmental comparison. Nepal has significantly improved in healthcare delivery in the last few decades, and there is a lot more to improve like in any health care system. There is no such thing like a perfect healthcare system in the world.”
“Nepal may need to prioritize a few fundamental aspects first.”
“Enhancements in communication skills, patient-centric care, and the recognition of patients as customers with fundamental rights are important,” he said, adding that the basics for MBBS students is not only to be proficient in clinical knowledge but also adept at actively listening to their patients.
“While the clinical exposure in Nepal is commendable, the teaching of effective communication skills and fostering a patient-centric approach remain a significant gap in the system.”
Dr Sapkota then gave an example of the medical procedures in the United States. “In the United States, the approach to medical procedures involves a comprehensive engagement with both patients and their families. Prior to any intervention, doctors conscientiously spend time with the patient and if needed with family, outlining all pertinent medical procedures. There is seamless and effective communication between medical professionals and those under their care. Moreover, doctors are dedicated to allocating ample time to cater to the concerns and queries of both patients and their families.”
A significant aspect of the healthcare system in the United States involves the practice of patients providing feedback and rating their doctors based on their level of satisfaction. This transparent approach enables healthcare providers to precisely identify areas that require improvement, according to him.
This collaborative and introspective methodology shows the understanding that perfection is an ongoing journey rather than an endpoint, according to Dr Sapkota.
According to him, there can be such feedback mechanisms in the Nepali healthcare system too. “But there are real challenges and it’s always work in progress.”
Dr Sapkota pointed out an important area to improve–active participation of all health care institutions in Nepal to deepen knowledge by conducting high quality local research and quality projects. “While there has been some activity in this area, more needs to be done. For outcome research, a good source of data is needed, comprehensive data needs more clinical time with patients from providers and timely and complete documentation of the healthcare records. These records can help conduct excellent clinical research and its outcome can help healthcare institutions offer better, safer, and more personalized care and coordination.”
“Patients should also be given access to review their health data, as it can provide valuable insight into their evolving health. This practice will make them more informed, involved and empowered to adapt to their medical decision-making and lifestyle adjustments. This likely will lead to improved care outcomes and patient satisfaction,” he said.
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So what next in life? I asked. “For now, I am enjoying practicing gastroenterology and teaching fellows/residents/students in the States. But for the future, I have plans,” he said. Looking ahead, Dr Sapkota sees himself returning to Nepal in the future and dedicating significant time to contribute to Nepali medical community.
“I have a strong desire to spend time in both Nepal and the United States in the future. My intention is to share my knowledge with medical students in Nepal, sharing the expertise I have gained during my time in the USA. Being a Nepali at heart, I am eager to contribute back to my home country. Nepal is where I was born and raised, and it laid the foundation for my medical education.”
As a vice president of the America Nepal Medical Foundation, an association of people from all sectors wanting to contribute to advancing health care in Nepal, Dr Sapkota also envisions himself teaching Nepali medical students in the future.
“There is an education committee and collaboration committee within ANMF, which has been actively involved in transferring knowledge through virtual grand rounds, webinars, and forum discussions. The critical care forums have been successful in connecting critical care specialists here in the United States with ICU providers in various institutions in Nepal.”
According to him, Karnali Academy of Health Sciences and ANMF have agreed to work together in advancing healthcare in Nepal with particular focus on the Karnali region. “We are hoping to have the memorandum of understanding finalized soon regarding this.”
Following the agreement, the ANMF collaboration committee will identify interested experts in desired specialties, will work on delivery of grand rounds, lecture virtually or in person as feasible. The collaboration will provide a broader learning opportunity to both students and clinicians, he believes.
Similarly, the foundation is also actively engaged in capacity building and manpower training in areas of need such as facilitating fellowship programs for medical professionals in high need specialty areas in Nepal.
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Before concluding, Dr Sapkota shared his plans to establish a “Gut Club” that would bring together gastroenterologists and hepatologists from both Nepal and the United States. The primary objective of this club would revolve around the exchange of ideas, knowledge-sharing, and comprehensive discussions on the most effective treatment methodologies for patients, he concluded.
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